American Academy of Orthopaedic Surgeons March 10-14, 2004 · San Francisco, CA Podium Presentations

Effects of Epidural Steroids in the Lumbar Spine:
A Double Blind Randomized Control Trial

Friday, March 12, 2004
11:54 AM - 12:00 PM

Location: Room 250-262

Daniel Steinitz, MD Belleville ON Canada
Edward J Harvey, MD Montreal QC Canada (*)
Max Aebi, MD Bern Switzerland (*)
Philip Lander, MD Montreal QC Canada (*)
Vincent Arlet, MD Montreal QC Canada (*)
Dante Marchesi Montreal QC Canada (*)

Spine

This paper reports the results of a randomized, blinded, control trial evaluating the efficacy of epidural and translaminar steroid injections.

Hypothesis:    The addition of steroid to epidural lumbar injection may provide a measurable functional improvement after treatment.

Methods:    The high incidence of lumbar pain syndromes has driven the search for an effective strategy for dealing with these patients. Much debate over the efficacy of lumbar steroid injection exists and many studies show conflicting results. Fifty patients were randomized by the even/ odd last digit of their hospital unit number. All patients with previous spinal injection or spinal surgery were excluded. All patients received an epidural injection of Xylocaine and Marcaine and the even group received additional 12mg of betamethasone. All injections were performed by the same interventional radiologist and all injections were confirmed with fluoroscopy and 2ml Omipaque dye. Patients completed all outcome measure questionnaires preinjection, two weeks post injection and two months post injection. All testing was performed by the same blinded research assistant.

Summary of Results:    No differences were found between patients receiving steroids and those that did not, with reference to any outcome measure. Musculoskeletal Functional Assessment (p < 0.29, p<0.68), Bother Index (p<0.50, p,0.22), Functional Index (p<0.22, p<0.73), Oswestry Score (p<0.16, p<0.11), Visual Pain Analogue Score (p<0.50, p<0.18)

Conclusion:    No significant differences could be detected between patients that did or did not receive steroid injection. This study may provide evidence against the use of steroid in epidural lumbar spinal injection.

Floor discussion immediately follows paper presentation.